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ZIKV Infection: Local Transmission in United States

Aedes aegypti, the most common mosquito vector of ZIKV globally, is present in Puerto Rico. Therefore, the virus is expected to continue to spread throughout Puerto Rico, posing risk of infection to 3.5 million residents, including about 43,000 pregnant women per year.

The first locally acquired case of Zika virus disease in Puerto Rico was identified in early December 2015, and 29 additional laboratory-confirmed cases have been detected since, including in one pregnant woman and in a man with Guillain-Barré syndrome.

Zika virus, a mosquito-borne flavivirus, spread to the Region of the Americas (Americas) in mid-2015, and appears to be related to congenital microcephaly and Guillain-Barré syndrome (1,2). On February 1, 2016, the World Health Organization (WHO) declared the occurrence of microcephaly cases in association with Zika virus infection to be a Public Health Emergency of International Concern. On December 31, 2015, Puerto Rico Department of Health (PRDH) reported the first locally acquired (index) case of Zika virus disease in a jurisdiction of the United States in a patient from southeastern Puerto Rico. During November 23, 2015–January 28, 2016, passive and enhanced surveillance for Zika virus disease identified 30 laboratory-confirmed cases. Most (93%) patients resided in eastern Puerto Rico or the San Juan metropolitan area. The most frequently reported signs and symptoms were rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three (10%) patients were hospitalized. One case occurred in a patient hospitalized for Guillain-Barré syndrome, and one occurred in a pregnant woman. [CDC]

Clinicians in Puerto Rico are now required to report all cases of microcephaly, Guillain-Barré syndrome, and suspected Zika virus infection to PRDH. “Other adverse reproductive outcomes, including fetal demise associated with Zika virus infection, should be reported to PRDH.”

Index case. The first case of Zika virus disease identified in Puerto Rico occurred in a man aged 80 years with multiple chronic medical conditions, who reported onset of symptoms on November 23, 2015.

Eight days after illness onset, he was evaluated in a hospital emergency department for progressive weakness after several days of watery, nonbloody diarrhea, recent episodes of falling, shoulder pain, chills, malaise, and abdominal pain. He did not report myalgia, headache, or retro-orbital pain. He was febrile, tachycardic, tachypneic, and hypotensive, with bilateral erythematous sclera. Laboratory results revealed leukocytosis with a predominance of neutrophils; hemoconcentration; thrombocytopenia; elevated serum transaminases, blood urea nitrogen, and creatinine; hyponatremia; and hypoglycemia. He received a diagnosis of sepsis, was admitted to the intensive care unit for fluid resuscitation and monitoring, and was treated with broad spectrum antibiotics. Diagnostic considerations included leptospirosis and dengue. He experienced respiratory decompensation requiring intubation and 5 days of mechanical ventilation. He was hospitalized for 2 weeks, during which time he underwent an extensive evaluation. Blood and stool cultures were negative, as were serologic tests for human immunodeficiency virus, Leptospira, and Strongyloides. Schistosoma immunoglobulin G titers were elevated, for which praziquantel was administered. On December 2, serum was collected for dengue and chikungunya diagnostic testing, and was positive for anti-dengue virus IgM, negative for anti-chikungunya virus IgM, and negative for detection of dengue virus and chikungunya virus RNA. Because a hospital-based enhanced surveillance protocol was in place for detection of Zika virus, the same serum specimen was tested for Zika virus infection by RT-PCR with a positive result. Confirmatory molecular diagnostic testing was performed at CDC. Detection of anti-dengue virus IgM antibody likely was a result of cross-reactive anti-Zika virus IgM antibody. Although no pathogen other than Zika virus was identified, the patient’s clinical course suggests that he also had an occult bacterial infection. Read more…

Disease Outbreak News – 12 February 2016 – Mirrored from WHO

Sexually transmitted ZIKV infection in Dallas, Texas

On 5 February 2016, the National IHR Focal Point for the United States of America notified PAHO/WHO of a probable case of sexual transmission of Zika virus.

Person A, a resident of Dallas, Texas, travelled to Venezuela for one week between late December and the beginning of January. Several days after returning to the United States, Person A developed symptoms consistent with Zika virus infection, including fever, rash, conjunctivitis, and malaise. One day prior to symptom onset and once during the symptomatic period, Person A had sex with Person B (non-traveller). Approximately one week after the onset of illness in Person A, Person B developed symptoms consistent with Zika virus disease, including fever, pruritic rash, conjunctivitis, small joint arthralgia and malaise.

Laboratory tests confirmed Zika virus infection in both Person A and Person B. Samples collected from Person A at 14 days after symptom onset and from Person B at 4 and 7 days after illness onset had evidence of Zika virus IgM and neutralizing antibodies. Additional tests are being carried out. Local meteorological conditions at the time would not have supported mosquito activity; furthermore, entomological sampling that was conducted in the concerned area yielded no mosquitoes. Read more…